Screening algorithm

 Sample and test numbers 

Few studies have examined the number of stool specimens necessary to optimise the diagnostic performance of FOBT. Consideration should be given to using more than one specimen together with criteria for assigning positivity which together provide a referral rate that is clinically, logistically and financially appropriate to the screening programme. The clinical sensitivity and specificity of testing can be modified depending on how the test data are used. Guaiac-based tests typically use 3 stools, but an algorithm using additional tests can be used to adjust clinical sensitivity and specificity

Determining test positivity

The choice of a cut-off concentration to be used in an immunochemical test to discriminate between a positive and negative result will depend on the test device chosen, the number of samples used and the algorithm adopted to integrate the individual test results. Whilst an increasing number of studies are reporting the experience of different algorithms, local conditions, including the effect on sample stability of transport conditions, preclude a simple prescribed algorithm at this time. Adoption of a test device and the selection of a cut-off concentration should follow a local pilot study to ensure that the chosen test, test algorithm and transport arrangements work together to provide a positivity rate that is clinically, logistically and financially acceptable

Test interference:  

 Dietary restriction 

 Dietary constituents present potential interference in guaiac faecal occult blood tests. Dietary restriction has not been demonstrated to significantly increase screening specificity, and risks reducing participation rate. The potential for dietary interference is significantly less for immunochemical tests. With the qualification that a diet peculiar to a particular country or culture may not have been tested or reported, dietary restriction is not indicated for programmes using either guaiac-based or immunochemical tests 

 Drug restriction 

 Interference from bleeding associated with drugs such as aspirin, nonsteroidal anti-inflammatory drugs and anticoagulants (e.g. warfarin) present potential interference in both guaiac and immunochemical faecal occult blood tests. Although the literature carries some contradicting reports of the effect of anticoagulants on screening outcome, drug restriction is not recommended for population screening programmes using either guaiac-based or immunochemical tests